Provider Demographics
NPI:1245085836
Name:IRC-RENASOLVE ROSEBURG JOINT VENTURE LLC
Entity type:Organization
Organization Name:IRC-RENASOLVE ROSEBURG JOINT VENTURE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:171 NW MEDICAL LOOP STE 109
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8690
Mailing Address - Country:US
Mailing Address - Phone:541-900-6910
Mailing Address - Fax:541-900-6911
Practice Address - Street 1:171 NW MEDICAL LOOP STE 109
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8690
Practice Address - Country:US
Practice Address - Phone:541-900-6910
Practice Address - Fax:541-900-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment